Perioperative Breast Analgesia

Abstract

Breast surgery is exceedingly common and may result in significant acute as well as chronic pain. Numerous options exist for the control of perioperative breast pain, including several newly described regional anesthesia techniques, but anesthesiologists have an insufficient understanding of the anatomy of the breast, the anatomic structures disrupted by the various breast surgeries, and the theoretical and experimental evidence supporting the use of the various analgesic options. In this article, we review the anatomy of the breast, common breast surgeries and their potential anatomic sources of pain, and analgesic techniques for managing perioperative pain. We performed a systematic review of the evidence for these analgesic techniques, including intercostal block, epidural administration, paravertebral block, brachial plexus block, and novel peripheral nerve blocks.

<p>Ultrasound-Guided Multilevel Thoracic Paravertebral Block and Its Efficacy for Surgical Anesthesia During Primary Breast Cancer Surgery</p>

“…Therefore, we believe the cause of pain during surgery was not due to a failure of the 6m-TPVB per se but due to afferent nociception from an area of the breast, ie, the pectoralis major muscle and its fascia, that is innervated by the medial and lateral pectoral nerves and not affected by a 6m-TPVB. Our results support Woodworth et al's 22 assertion that breast surgery involving the pectoral muscles, eg, MRM, requires more than just a 6m-TPVB for surgical anesthesia or analgesia. 22 Given the above, why the 6m-TPVB was still effective as the sole anesthetic in 20% of our patients is not clear, and probably multifactorial, but extensive epidural spread in these cases cannot be excluded.…”

Opioid-free mastectomy in combination with ultrasound-guided erector spinae block: A series of five cases

“…[ 6 ] Pectoral blocks and serratus anterior plane blocks have been used with variable efficacy with GA but have its limitations as it causes sparing of supraclavicular nerves, intercostobrachial nerve and also disrupts surgical planes. [ 7 ] Forero et al . described ESP block for treating thoracic neuropathic pain with encouraging results.…”

Paravertebral block with morphine or dexmedetomidine as adjuvant to bupivacaine for post-operative analgesia in modified radical mastectomy: A prospective, randomised, double-blind study

“…[ 3 ] Pain if underestimated and untreated can be detrimental to the patients' homeostasis and recovery. [ 4 ] A variety of local and regional anaesthetic procedures which include local anaesthetic infiltration, field block, intercostal nerve blocks, brachial plexus blocks and thoracic epidural anaesthesia for breast surgery have been described [ 5 ] to avoid problems encountered with GA, reduce the post-operative hospital stay and for better outcome. Paravertebral block (PVB) can be considered as a well-established option to provide analgesia during breast surgery.…”